Relationship between death anxiety and coping with death competence among Chinese oncology nurses: A chain mediation model

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BACKGROUND: Death anxiety (DA) is a prevalent psychological challenge among oncology nurses that affects their emotional well-being and professional competence in coping with death-related situations. Death-related attitudes and resilience are critical factors that may mediate the relationship between DA and coping with death competence (CDC). However, few studies have examined the chain-mediating effect of these factors among Chinese oncology nurses. This study aimed to investigate the association between DA and CDC among Chinese oncology nurses, with a focus on the mediating roles of death attitude and resilience. AIM: To investigate the association between DA and CDC among Chinese oncology nurses. METHODS: A national cross-sectional survey was conducted among Chinese oncology nurses using an electronic questionnaire distributed in Wenjuanxing, China. In total, 615 valid responses were obtained. The participants completed the Templer death anxiety scale, death attitude profile-revised, Connor-Davidson resilience scale, and coping with death scale. A chain mediation analysis was performed using the PROCESS macro in SPSS to examine the relationships between these variables. RESULTS: The findings indicated that DA had a significant direct effect on CDC [effect = 0.201, 95% confidence interval (CI): 0.112-0.322]. In addition to this direct effect, three significant indirect pathways were observed: (1) Death attitude (effect = 0.118, 95%CI: 0.056-0.163); (2) Resilience (effect = 0.108, 95%CI: 0.032-0.176); and (3) A sequential mediation pathway involving both death attitude and resilience (effect = 0.071, 95%CI: 0.042-0.123). The total indirect effects of the three mediation paths accounted for 29.7% of the relationship between DA and CDC. CONCLUSION: Using a chain mediation model, this study explored the mechanisms linking DA, death attitude, resilience, and CDC among Chinese oncology nurses. These findings highlighted the crucial role of death attitude and resilience in mediating the relationship between DA and CDC. Interventions aimed at fostering adaptive attitudes toward death and enhancing resilience may improve nurses' ability to cope with death-related stressors, ultimately benefiting their psychological well-being and professional competence.

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